Trends in aortic valve replacement in Germany in 2015: transcatheter versus isolated surgical aortic valve repair
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We analysed the number of procedures, indications, and in-hospital mortality rates of all patients undergoing isolated surgical aortic valve replacement (sAVR) or transvascular (TV-) and transapical (TA-) transcatheter aortic valve implantation (TAVI) from 2012 to 2015 in Germany.
Methods and results
More than 31,000 aortic valve procedures were performed in 2015 in Germany, representing a total increase of 4.5% over 2014. TV-TAVI accounts for 13,108 of these procedures, with an increase of 21%, whereas the numbers of isolated sAVR and TA-TAVI decreased slightly. Age, frailty, high risk, and patients’ choice were the main reasons for a catheter-based intervention. In 2015, the in-hospital mortality rate after TV-TAVI decreased to 3.4%, approaching that of sAVR (2.9%), despite a considerably higher baseline risk. A stratified analysis according to the German aortic valve (AKL) score demonstrated a further decrease of the in-hospital mortality for TV-TAVI, showing a lower in-hospital mortality rate than expected in all risk groups. Importantly, this also accounts for the lowest risk group with an AKL score <3% showing an in-hospital mortality rate of 1.7%, which is now comparable to that of sAVR (1.5%). In all other risk groups, the in-hospital mortality in patients undergoing TV-TAVI was lower than in patients undergoing sAVR.
Mortality after TV-TAVI keeps decreasing over the last years and equals that of SAVR in the lowest risk cohort in the meanwhile. All TV-TAVI patients have significantly lower observed than expected mortality, which will further lead to a redefinition of standard of care.
KeywordsTAVI Aortic valve replacement Outcome Mortality Logistic EuroScore AKL score
We thank Elizabeth Martinson, Ph.D., of the KHFI Editorial Office for her editorial assistance. We also thank Emilie Hofstetter for her assistance in analysing the data.
Compliance with ethical standards
Conflict of interest
Helge Möllmann received speaker honoraria and/or travel grants from Edwards Lifesciences, St. Jude Medical, Symetis SA. Luise Gaede and Johannes Blumenstein received travel grants from Edwards Lifesciences, St. Jude Medical, Symetis SA. Won Keun Kim is a proctor for St. Jude Medical and Symetis SA.
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